455 Boston Post Road, Suite 10 Old Saybrook, CT 06475

(860) 388-9799



Privacy Officer: Heather Larson 860-388-9799

The following is a brief summary of your rights and our responsibilities as detailed in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA strengthens the provisions in the federal Privacy Act of 1974. This summary is provided for patient convenience and is not a substitute for reading the entire Notice, nor does it modify the terms of the Notice. Patients desiring a copy of the entire Notice should contact the Privacy Officer listed above.

1. Uses and Disclosures of Your Health Information. Saybrook Dermatology, LLC may use the information its staff develops and collects for 1) treatment, and may disclose the information to others to whom patients are referred for treatment; 2) for payment for these services; 3) for certain health care “operations” such as improving competence and quality of staff; 4) business planning and management. Saybrook Dermatology, LLC may disclose patient information to its business associates such as medical transcriptionists, billing services and others who assist in Saybrook Dermatology, LLC’s operation. Saybrook Dermatology, LLC contracts an automated confirmation service that will call patients to remind them of appointments and leave messages on answering machines. Saybrook Dermatology, LLC may also disclose information to patients’ family about location, general condition or death; if patients are available and able, Saybrook Dermatology, LLC will obtain prior consent. Saybrook Dermatology, LLC may also use patient information to recommend products or services related to care, but will not use or disclose medical information for marketing purposes without prior written authorization to do so. Prior authorization will be obtained from patients participating in a medical study. Medical information may be disclosed without authorization as required by law, for public health purposes, healthcare oversight (audits and investigations), judicial and administrative proceedings, subject to the limits imposed by state and federal law, and certain other purposes.

2. Other Uses and Disclosures. Except as described in the Notice, Saybrook Dermatology, LLC will not use or disclose medical information without written authorization. Patients can revoke authorization at any time, except to the extent that Saybrook Dermatology, LLC has already taken action in reliance on the authorization.

3. Patient Health Information Rights. Patients have a number of rights under state and/or federal law which are subject to the terms and condition specified in the Notice:

  1. Patients may request restrictions on the release of their healthcare information.
  2. Patients may request to receive information from Saybrook Dermatology, LLC in a certain way.
  3. Patients may inspect and copy their medical records.
  4. Patients may request an amendment to record entries they feel are inaccurate.
  5. Patients may request an accounting of disclosures made from their medical record.

4. Changes to the Notice. Any changes to the Notice will be posted in Saybrook Dermatology LLC’s waiting room. A copy will be provided upon request.

5. Complaints. Patients may file a complaint with the Privacy Officer listed above or with the federal government as detailed in the Notice. Patients will not be penalized for filing any complaint.

Saybrook Dermatology


455 Boston Post Road, Suite 10,
Old Saybrook, CT 06475

Office Hours


8:00 am - 5:00 pm


8:00 am - 5:00 pm


8:00 am - 5:00 pm


8:00 am - 5:00 pm


8:00 am - 4:30 pm